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Who's Taking the Tech Route on Patient Care?
New ACP survey sheds light on telemedicine adoption and hurdles
May 17, 2019 (ACP) – Slightly more than 50 percent of American College of Physician members are using some type of telemedicine in their practices, according to a new ACP survey that highlights the need for both education and guidance on the technology.
Telemedicine – the use of technology to deliver care from a distance – is actually being used in a variety of ways, from e-consults with colleagues and the exchange of digital files to remote patient monitoring and patient visits via video.
The survey, based on a random sampling of 1,449 of ACP's internal medicine physicians and subspecialists, found that more than half of the respondents said they were interested in learning more about telemedicine, regardless of whether they currently own the technology.
It also found that usage varies widely by application. For instance, about 33 percent of respondents have e-consult technology, and 63 percent of those with this technology said they use it frequently. By contrast, remote care management or video visits are less widely available, the survey showed.
“ACP recognizes that telehealth technologies have the potential to improve access for patients, enhance patient-physician collaboration, improve health outcomes, increase patient satisfaction and reduce medical costs,” Dr. Ana María López, ACP's immediate past president, said. “Our survey gave us valuable information about the state of telehealth adoption among internists, what we can do to improve it and how we can lead internal medicine physicians in the appropriate use of telehealth.”
In fact, expanding the use of telemedicine in the primary care setting has long been an ACP goal. The College first made recommendations about delivery and reimbursement in a 2015 position paper that called for the development of evidence-based guidelines.
Yet despite the increase in interest and use, hurdles to wider adoption of telehealth services do exist, said Margo Williams, a senior associate for practice management at ACP. Reimbursement remains an issue, but the Medicare agency's latest Physician Fee Schedule created new telehealth codes and payments for e-consults, remote monitoring and virtual check-ins, she said.
“Some private payers are also paying for telehealth under specific circumstances, some through grant waivers and others through coverage policies,” Williams said.
Regulatory impediments remain as well, she said.
“The regulations vary greatly from one state to the next, much of which is related to interstate licensure and how state Houses and medical boards define who can do what and under what circumstances,” Williams said. “But, much is happening … both regarding coverage and licensure.” For example, Virginia recently passed legislation requiring coverage for remote patient monitoring, she said.
“The industry is growing – with a lot of potential for exploding – as more and more patients want it, as technologies make it easier, as reimbursement for using telehealth expands and as physician specialty shortages continue, especially in rural areas,” Williams said.
ACP's survey also showed that simply having telemedicine technology available does not necessarily mean that doctors will use it. Physicians find it challenging to integrate telehealth into their practice's workflow, and they worry about patient access and the potential for medical errors.
Among those with telehealth technology, just 19 percent of survey respondents said they use video visits every week, compared with 50 percent who use remote care management every week. Those who analyzed the survey results say this suggests that more guidance is needed on why and how to incorporate telehealth into a practice's workflow and on how to bill for it.
“ACP is working on tools and resources to help our members implement various aspects of telehealth,” Williams said. “I envision starting with the e-consults, virtual video visits with patients and remote monitoring, such as sending/receiving data from medical devices such as continuous glucose monitors, pulse oximeters and heart monitors,” she said.
Increasing physician participation with telehealth is important, Williams said, because it does have the potential to improve patient care.
“For patients who have trouble getting to the office – who don't drive or are in a wheelchair or live one to two hours away – but need regular monitoring, telehealth can offer in-between monitoring and coaching, which can keep patients out of ERs and hospitals,” she said. “If the patient with multiple chronic conditions is an established patient, then the physician can find out what's going on with the patient more often than might otherwise be possible.”
Although ACP sees potential benefits in expanding the role of telemedicine, the College also notes that physicians must be able to use their professional judgement to determine whether the use of telemedicine would be appropriate for a specific patient and in a specific situation.
ACP's position paper on telehealth – Policy Recommendations to Guide the Use of Telemedicine in Primary Care Settings – is available on the Annals of Internal Medicine website.